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B-2016-1904CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1904 10420 BUBB RD CUPERTINO, CA 95014-4150 (357 20 038) NU REV COMMUNICATIONS INC LIVERMORE, CA 94550 OWNER'S NAME: HOME OF CHRIST CH CUPERTINO LLC DATE ISSUED: 07/05/2016 OWNER'S PHONE: 925-456-2997 PHONE NO: (925) 980-2799 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class LOW VOLTAGE SYSTEMS Lie. #962583 Contractor NU REV COMMUNICATIONS INC Date 06/30/2017 X BLDG _ ELECT _ PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing _ MECH _ RESIDENTIAL X COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION:, T.I. - T MOBILE; ROOFTOP CELL SITE: REMOVE & REPLACE 5 I hereby affirm under penalty of perjury one of the following two declarations: ANTENNAE, INSTALL 3 RRUS, INSTALL 3 TMA!, AND INSTALL 3 1. I have and will maintain a certificate of consent to self-insure for Worker's DIPLEXERS Compensation, as provided for by Section 3700 of the Labor Code, for the J performance of the work for which this permit is issued. a I have and will maintain Worker's Compensation Insurance, as provided for by 1-14' 1 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $20000.00 APPLICANT CERTIFICATION certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 357 20 038 A (Tenant Improvements),A (Ten nit Improvements),A representatives of this city to enter upon the above mentioned property for (Tenant Improvements),A (Tenan bnprovements),A inspection purposes. (We) agree to save indemnify and keep harmless the (Tenant Improvements),A (Tenn i Improvements),A City of Cupertino against liabilities, judgments, costs, and expenses which (Tenant Improvements),A (Tenan Improvements),A may accrue against said City in consequence of the granting of this permit. (Tenant Improvements),A (Tenan Improvements),A Additionally, the applicant u rstands and will comply with all non-point (Tenant Improvements) source regulations per the Cupe "noMunicipal Code, Section 9.18. � PERMIT EXPIRES IF WORK ISN T STARTED Signature Date 7/1 p' � f WITHIN 180 DAYS OF PERMIT I SUANCE OR OWNER-BUILDER DECLARATION 180 DAYS FROM LAST CALLED INSPECTION. I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: Issued by: Abby Ayende 1. I, as owner of the property, or my employees with wages as their sole Date: 07/05/2016 compensation, will do the work; and the structure is not intended or offered for sale (Sce.7044, Business & Professions Code) RE-ROOFS: 2. I, as owner of the property, am exclusively contracting with licensed All roofs shall be inspected prior to any roofing material be Ing installed. If a roof is contractors to construct the project (Sec.7044, Business & Professions Code). installed without first obtaining an inspection, I agree to rern eve all new materials for I hereby affirm under penalty of perjury one of the following three declarations: inspection. 1. I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Signature of Applicant: performance of the work for which this permit is issued. Date; 7/5/201 2. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER permit is issued, s. I certify that in the performance of the work for which this permit is issued, I HAZARDOUS MATERIALS DISCLO URE' shall not employ any person in any manner so as to become subject to the I have read the hazardous materials requirements under Chapter 6.95 of the Worker's Compensation laws of California. If, after making this certificate of California Health & Safety Code, Sections 25505,255:33, and 25534. I will exemption, I become subject to the Worker's Compensation provisions of the maintain compliance with the Cupertino Municipal Cod , Chapter 9.12 and the Labor Code, I must forthwith comply with such provisions or this permit shall Health & Safety Code, Section 25532(a) should I store or handle hazardous be deemed revoked. material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I APPLICANT CERTIFICATION will maintain compliance with the Cupertino Municipal ode, Chapter 9.12 and I certify that I have read this application and state that the above information is the Health & Safety Code, Sections 2p—q, 25533, and 25534. correct. I agree to comply with all city and county ordinances and state laws V �; relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree Owner or authorized agent: to save indemnify and keep harmless the City of Cupertino against liabilities, Date: 7/5/2016 judgments, costs, and expenses which may accrue against said City in of the this Additionally, the applicant understands CONSTRUCTION I hereby affirm that there is a construction lending ag c r the performance consequence granting of permit. and will comply with all non-point source regulations per the Cupertino Municipal of work's for which this permit is issued (Sec. 3097, CN C.) Code, Section 9.18. Lender's Name Lender's Address Signature Date 7/512016 - ARCHITECT'S DECLARATTO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT . BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 +wUP RTINQ (408) 777-3228 • FAX (408) 777-3333 • building ecupertino.ora [:]NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRFD ORIGINAL PERMIT If PROJECT ADDRESSr��..� &� 'i7 : o —��--(V_JC APN # �567 . 26 ... O'S OWNER �(1 e �{it C.► LVLT V! 1 (� i l ONE 12 -MAIL STREET ADDRESS/6 DDRESSCI AAbb F, ,t STATE, ZIP FAX - O ��1. , CONTACT NAME PF NE E I ST`T DRE C TY, STATE, L FAX ❑ OWNER ❑ OWNER -BUILDER ❑. OWNERAGENT 0 CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DFVE.OPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS, LTC# COMPANY NAME E-MAIL FAX STREETADDRESS CITY, STATE, ZIP _ PHONE. ARCH :rF'(-T1RNr.INr4RR NAMR LICENSE NUMBER .- V BUS. LIC # FAX COMIPANY NAME E-MAIL STREET AD 4W C14 STATE, \ � �G+•-��.-/ '�G-N� T�— fQ OF WORK _ D 1S)"q V\ Y\ Mo 19i I e-1 EXISTING USE - - - PROPOSEDUSE - - CONSTR, TYPE #STORIES USE TYPE OCC, SQ.FT. VALUATION {$) EXISTO NEW FLOOR DEMO TOTAL - AREA AREA. AREA NETAREA BATHROOM KITCHEN OTHER - - - - REMODEL AREA REMODEL AREA REMODEL AREA PORCI-1AREA DECK AREA - - TOTAL DECKIPORCH AREA - GARAGE AREA: DETACH - ❑ATTACH # DWELLING UN iS A SECOND UNl'1' [[.YES SECOND STORY YESUEINGADDED? ONO ADDITION? ONO PRF -APPLICATION ❑ YES IF YES, PROVIDE COPY OF - IS THE BLDG AN ❑ YES RECEIVED $ ' , ' TOTAL VA LUATION: PLANNTNG ADPL# Q NO PLANNING APPROVAL LETTER ETCHLER HOMF? ONO By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on tfiefIrope'ity-owkIrs behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate, I agree to comply with all applicable local u ordinances and state laws relating tiridin c a truetion. I authorize representatives of Cupertino to enter the above-identifi7dropelty for inspect on purposes. Signature of Applicant/Agent:: Date: i SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUT NGSLIP ❑ OVER-THE-COUNTER sDILDINc PLAN REVIEW _ Now SFD or Multifamily dwellings: Apply for demolition permit for existing building(s), Demolition permit is required prior to issuance of building permit for new building, El EXPRFSS ire PLANyING PL 1I REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Q S•rANDAt2D D PUBLIC WOI foltin if any Hazardous Materials are being used as part. of this project. Q .LARGE FIRE DEPT _ Copy of Planning Approval Letter of Meeting with Planning prior to © MAJOR CI SANITARY SE ERDISTIUCT submittal of Building Permit application. ❑ ENVIRONME TAL HEALTH BtdgApp_2011,doc revised 06/21/11